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The Vitamin D Newsletter
August 6, 2010
Gary Null and Vitamin D Toxicity
This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you want to unsubscribe, go to the end of this newsletter. If you have not subscribed, you can do so on the Vitamin D Council’s website.Warning: If you intend to take massive doses of vitamin D based on this newsletter, which I highly recommend you do not, read the entire newsletter. In addition, accurate determination of side effects of massive doses of vitamin D was not available in the early 1930s, nor was accurate determination of the true amount in each pill possible.
Is 2,000,000 IU/day of vitamin D toxic?
Ask Gary Null, alternative medicine guru and entrepreneur. He took his own supplement, Ultimate Power Meal, for a month and became extremely ill; one batch of Power Meal apparently contained 1,000 times more vitamin D than it should. That is, it contained 2,000,000 IU of vitamin D3 per serving instead of 2,000 IU per serving. Mr. Null became sicker and sicker as he gulped it down.
After suing his own supplier for permanent physical damage, Mr. Null then reported it took 3 months to get the extra vitamin D out of his system and that he is now alive and well:
If Mr. Null took it for the full month that he claims, and if his Power Meal contained 2,000,000 IU per dose, Mr. Null consumed 60,000,000 IU in one month. Could he really be fine now with no lasting injuries?
In an attempt to answer that question, I went back to the 1930s and 40s.
Massive doses in the 1930s
The earliest references I could find to enormous doses of vitamin D were in the 1930s. In 1935, Drs. Dreyer and Reed, of the University of Illinois School of Medicine, published their observations on 700 patients treated with “massive” doses of vitamin D for up to two years.
Dreyer I, Reed CI. The treatment of arthritis with massive doses of vitamin D. Archives of Physical Therapy. 1935;16:537-43
First, the authors report that vitamin D had remarkable treatment effects on all kinds of arthritis, especially rheumatoid arthritis. They report on 67 arthritic patients so treated, with 75% of the patients responding most dramatically.
The dose used? Drs. Dreyer and Reed started all patients on 200,000 IU per day! They started some patients on 200,000 IU/day of D2 and others on 200,000 IU/day of D3, noticing no difference in efficacy. They used vitamin D preparations made by Mead Johnson, Glaxo, and Abbott.
“If there was no improvement and no evidence of sensitivity, the daily dose was increased by 50,000 units each week until there was some improvement or evidence of overdosage. In some stubborn cases, it was found necessary to increase to 600,000 or even 1,000,000 units for a few days and then reduce to 200,000 to 500,000 units. Most of our results have been obtained with daily doses of 300,000 to 500,000 units.”
The authors report that 63 of the 700 patients on this dosage became clinically toxic. That is, about 10% of the patients on these doses became sick (toxic) from the vitamin D. Today, we usually think of vitamin D toxicity as asymptomatic high blood calcium but these were old time doctors; toxic meant sick.
How did they treat the 63 patients who became sick from massive doses of vitamin D? Hospitalize them in the ICU? No, they simply stopped the vitamin D, told them to drink plenty of fluids, waited for the symptoms of toxicity to dissipate, and then restarted them on a lower dose, such as 150,000 IU per day.
The authors do mention that many of the patients had high blood calcium, one in the 20s, but if the patients were not sick, the doctors didn’t care about the calcium. As the authors did not draw serum calcium on all of the 700 patients, we don’t know what percentage of patients on these doses became hypercalcemic.
Symptoms of Toxicity
The authors report that the symptoms of vitamin D toxicity began with persistent nausea, which the doctors instructed their patients to be on the lookout for, as well as increased frequency of urination without increased volume of urine. Weakness and increased thirst were common, and “if the treatment is continued, diarrhea, gripping pain in the gastrointestinal tract, and vomiting.” The authors bragged that they could not report on pathological findings in toxicity, because none of their 700 patients had died and “come to autopsy.”
In 1934, the Journal of the American Medical Association published a study on vitamin D overdose:
Reed CI. Symptoms of Viosterol overdosage in human subjects. JAMA. 1934;102:1745-1748.
They reported on 300 patients given high doses of vitamin D2 for asthma and hay fever. The author reported that each cc contained 900,000 IU of vitamin D2. The good doctor gave one patient 3 cc per day for five days (that would be a total dose of 13.5 million units) “without the slightest evidence of injury.”
However, in his conclusion, Dr. Reed was much more conservative,
“there need be little apprehension about the administration of amounts ranging up to 150,000 international units daily for indefinite periods. Larger amounts had better be limited to periods of a few months at most, depending on the therapeutic effects desired.”
Dr. Rappaport and colleagues at the University of Illinois studied the effects of Viosterol (vitamin D2) on asthma and hay fever in 212 patients, giving placebo to a control group. The authors reported that 82% of the hay fever patients and 96% of the asthma patients “experienced definitive significant relief.” The authors concluded that the “optimum dose” of vitamin D was 60,000 to 300,000 IU per day.
Rappaprt BZ et al. The treatment of hay fever and asthma with Viosterol of high potency. J. of Allergy. 1934;5:541-553.
Why these doctors did not try 5,000 or 10,000 IU/day, instead of 200,000 IU/day, I could not ascertain.
Death in the 1940s
Things began to change in the 1940s. In 1946, two case reports of fatal vitamin D toxicity in adults (the authors report five previous fatal cases in children) appeared in the medical literature.
Bauer JM and Freyberg RH. Vitamin D intoxication with metastatic calcification. JAMA 1946;130:1208-1215
Another case report of a fatal dose of vitamin D in adults appeared in 1947. This death was from Ertron, vitamin D2, at a dose of 150,000 IU daily for 18 months, and it included a description of foot lesions similar to what Gary Null reported. This paper is free to download and I suggest everyone who is flirting with the idea of using massive doses of vitamin D obtain it and read it. It is chilling to read the detailed autopsy report.
By 1948, the medical community began condemning the use of such massive doses of vitamin D as evidenced by a paper from Johns Hopkins University.
The authors reference 12 earlier papers on vitamin D intoxication with calcification of everything from the kidneys to the sclera of the eyes. The first symptoms of vitamin D toxicity in their series of 11 patients were weight loss and fatigue, which occurred before the anorexia (poor appetite) and vomiting. All of their patients suffered from kidney damage and anemia. Virtually all of the patients had a characteristic eye lesion, which are calcium deposits in the sclera and cornea, just beneath the conjunctival basement membrane.
All patients had high blood calcium, ranging from 12.4 to 15.1 mg per 100 cc. Dosages of vitamin D ranged from the lowest at 150,000 IU/day for 4 months (serum calcium 13.9) to the highest at 500,000 IU/day for 18 months (serum calcium 14.3). They reported on another patient who developed hypercalcemia after she reported taking 300,000 IU of vitamin D2 for only 2 weeks; she also had eye lesions evident on slit lamp exam. Although accurate follow up was not possible due to the fact the patients came from around the country, no patients died but some suffered permanent renal damage from the excessive doses of vitamin D.
The treatment the authors used for vitamin D toxicity was discontinuing the vitamin D, drinking 4,000 cc of fluid per day, and a low calcium diet. Improvement occurred within 2-8 weeks when nausea, vomiting, and lassitude disappeared. Blood calcium fell in all patients by one month but continued to be elevated for as long as a year in one patient.
These reports of toxicity were all the medical profession needed to condemn vitamin D as dangerous, as I learned in medical school in the early 1970s. The dark ages of vitamin D meant that for several generations of doctors, vitamin D was toxic at all but the most meaningless doses. Its use to treat asthma and arthritis became verboten. For fifty years, doctors forgot about vitamin D – other than vitamin D deficient rickets – because of fear of toxicity. During these dark ages, the Food and Nutrition Board periodically reviewed vitamin D and repeatedly distributed toxicity alarms, along with their recommendations that we only take insignificant doses.
Out of the dark ages
Then, at the turn of the century, Professor Reinhold Vieth of the University of Toronto showed us the way out of the dark ages with an objective review of the toxicity literature. The paper below is free to download.
What Vieth’s paper showed was that there is a difference between 5,000 IU per day and 50,000 IU per day, the first being a physiological dose and the second being a pharmacological dose, a drug. However, in 1999 the world was using neither dose properly, in that no doctors were prescribing 5,000 IU per day and no scientists were studying 50,000 IU per day.
After Vieth’s paper, in the first few years of this century, a steady stream of vitamin D papers began flowing out of research labs, with the number of publications increasing every year. For example, scientists published 1,582 new papers on vitamin D in the first six months of 2010. Very few are about toxicity, instead they cover a breathtaking variety of diseases. These papers raise the possibility that many of the diseases that we take as being part of the human condition are not part of the human condition, instead they are simply the result of the toxicity scare: vitamin D deficiency. That is, these diseases are simply different presentations of the same deficiency. In that way, vitamin D deficiency is similar to syphilis.
Sir William Osler said, “Know syphilis in all its manifestations and relations and all other things clinical will be added unto you. Know syphilis and the whole of medicine is opened to you.” He called it the “Great Imitator,” because late stages of syphilis simulate almost every disease known to man. Smoking is similar, some smokers get emphysema, some lung cancer, some heart disease, some bladder cancer, some pancreatic cancer, and some live to be 100. Increasingly, vitamin D deficiency looks as if it may do the same thing. Some vitamin D deficient people will get asthma, others cancer, others heart disease, others autoimmune illness, and some will live to be 100.
Let’s look at one rare disease, childhood multiple sclerosis, a nightmare for any parent to face. The child will have problems with vision, co-ordination, or balance, with relapses and remissions, that is the disease seems to come and go. Recently, Dr. Ellen Mowry and her colleagues discovered that these relapses, these periods of active autoimmune illness, are associated with low levels of vitamin D. The disease comes and goes as vitamin D levels come and go. Dr. Mowrey speculated that a 15 ng/ml increase in vitamin D levels would cut the relapse rate in half.
Dr. Mowry did not raise the fundamental question: would these children have become ill in the first place if they had adequate amounts of vitamin D during their growth and development? The average vitamin D level of these 110 children was 22 ng/ml, so Dr. Morey could not say what an increase to 50 ng/ml would do, nor could she say if low vitamin D levels were what allowed the disease to appear in the first place.
That is, is juvenile multiple sclerosis simply one of many possible presentations of childhood vitamin D deficiency? Some vitamin D deficient children will get multiple sclerosis, some asthma, some diabetes, some rickets, and others autism. That is, is vitamin D deficiency the modern day syphilis?
Unlike syphilis, vitamin D deficiency is largely an iatrogenic disease, caused by the medical profession’s near hysterical fear of vitamin D toxicity. Physicians simply forgot what Paracelsus said many years ago, “All things are poison and nothing is without poison, the dose alone permits something to be poisonous.” We went from intemperance in the 1930s to hysteria in the 1950s and we are only now coming to our senses.
We look around at the diseases debilitating our children, the triple A epidemics of autoimmune disorders, asthma, and autism. All are truly epidemic, all are debilitating or worse, and vitamin D is involved in all three. We failed to make sure our children had enough vitamin D throughout their growth and development and now our children suffer, in large part because of the hysteria over vitamin D toxicity.
What dose is toxic? I don’t know but I’d guess for some adults it is around 50,000 IU/day. However, it will vary widely and some people may get asymptomatic side effects on lower doses, such as kidney damage, without getting clinical signs of toxicity. Just because you feel fine, that does not mean your kidneys are fine.
Getting back to Mr. Gary Null and his ingestion of 60,000,000 IU over one month, could he have survived that dose? Apparently, the answer is yes, although I doubt he took it every day, especially as he got sicker and sicker. Could he have survived that dose without permanent kidney damage? I doubt it.
John Cannell, MD
Executive Director
Vitamin D Council
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A recent report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, adds to the growing evidence that fish oil supplements may play a role in preventing chronic disease.
Researchers at the Fred Hutchinson Cancer Research Center in Seattle, Wash., led by Emily White, Ph.D., a member of the public health sciences division, asked 35,016 postmenopausal women who did not have a history of breast cancer to complete a 24-page questionnaire about their use of non-vitamin, non-mineral “specialty” supplements in the Vitamins and Lifestyle (VITAL) cohort study.
After six years of follow-up, 880 cases of breast cancer were identified using the Surveillance, Epidemiology and End Results registry.
Regular use of fish oil supplements, which contain high levels of the omega-3 fatty acids, EPA and DHA, was linked with a 32 percent reduced risk of breast cancer. The reduction in risk appeared to be restricted to invasive ductal breast cancer, the most common type of the disease.
The use of other specialty supplements, many of which are commonly taken by women to treat symptoms of menopause, was not associated with breast cancer risk.
This research is the first to demonstrate a link between the use of fish oil supplements and a reduction in breast cancer. Studies of dietary intake of fish or omega-3 fatty acids have not been consistent.
“It may be that the amount of omega-3 fatty acids in fish oil supplements are higher than most people would typically get from their diet,” White said.
However, White cautioned against gleaning any recommendations from the results of one study.
“Without confirming studies specifically addressing this,” she said, “we should not draw any conclusions about a causal relationship.”
Edward Giovannucci, M.D., Sc.D., professor of nutrition and epidemiology at the Harvard School of Public Health and an editorial board member of Cancer Epidemiology, Biomarkers & Prevention, agreed.
“It is very rare that a single study should be used to make a broad recommendation,” said Giovannucci. “Over a period of time, as the studies confirm each other, we can start to make recommendations.”
Still, fish oil continues to excite many, as evidence emerges about its protective effect on cardiovascular disease and now cancer.
Harvard researchers are currently enrolling patients for the randomized Vitamin D and Omega-3 Trial (also called VITAL), which will assess the impact of fish oil supplements and vitamin D on cancer, heart disease and stroke.
The researchers plan to enroll 20,000 U.S. men aged 60 years and older and women aged 65 years and older who do not have a history of these diseases and have never taken supplements.
Provided by American Association for Cancer Research
ScienceDaily (June 21, 2010) — The use of Omega-3 supplements is effective among patients with major depression who do not have anxiety disorders, according to a study directed by Dr. François Lespérance of the Centre de recherche du Centre hospitalier at the Université de Montréal (CRCHUM), head of CHUM’s Department of Psychiatry and a professor at the Université de Montréal.
The study was published June 15 in the online Journal of Clinical Psychiatry.
This was the largest study ever conducted assessing Omega-3′s efficacy in treating major depression. It was carried out in conjunction with researchers from centres affiliated with the UdM’s Réseau universitaire intégré de santé (RUIS), from McGill University, Université Laval in Quebec City and Queen’s University in Kingston, Ontario. The study was supported by the European firm isodisnatura, the Fondation du CHUM and the CRCHUM.
Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder. Efficacy for these patients was comparable to that generally observed with conventional antidepressant treatment.
From October 2005 to January 2009, 432 male and female participants with major unipolar depression were recruited to take part in this randomized, double-blind study (neither patients nor researchers knew which capsules patients received). For eight weeks, half of the participants took three capsules per day of OM3 Emotional Balance, a fish oil supplement containing high concentrations of eicosapentaenoic acid (EPA). The other half took three identical capsules of a placebo consisting of sunflower oil, flavoured with a small quantity of fish oil. In contrast with typical clinical studies designed to assess the effectiveness of antidepressants, this study included a high proportion of patients with complex and difficult-to-treat conditions, including patients resistant to conventional antidepressant treatments and patients also suffering from an anxiety disorder. The aim was to assess the value of Omega-3 supplementation in a group of individuals more like those treated in outpatient clinics.
Need to assess the impact of Omega-3 supplements
Some 11% of men and 16% of women in Canada will suffer from major depression at some point in their lives, making this disorder one of our society’s leading public health issues. Depression, which is now the world’s fourth leading cause of morbidity and death is expected to move up to the number two position by 2020. “Despite significant progress in neuroscience over the past two decades, depression is difficult to treat,” Dr. Lespérance noted. In view of the large number of patients who stop taking their medications in the first few months of treatment and those who refuse such treatment due to fear of stigmatization or side effects, it comes as no surprise that a large number of patients suffering from major depression use alternative treatments offered outside the healthcare system. “Many of these treatments have not been adequately evaluated. That is why it was important to assess the efficacy of Omega-3, one of the most popular alternative approaches,” he added.
Epidemiological and neurobiological studies have suggested that a relative deficit in polyunsaturated fatty acids of the Omega-3 group may predispose individuals to psychological disorders such as depression. Further, several preliminary clinical studies based on small numbers of patients have suggested that Omega-3 supplements with high concentrations of EPA can help to reduce symptoms of depression among patients who fail to respond to an initial antidepressant treatment. These studies have not, however, convinced the entire scientific community. A broader study was needed to acquire further knowledge about the properties and efficacy of high-quality Omega-3 supplements among patients suffering from major depression.
“We are proud that OM3 Emotional Balance, with its high concentration of EPA at unexcelled levels of purity delivers the dose of EPA needed for effective treatment,” said Claire Bertin, head pharmacist for isodisnatura, the laboratory producing the Omega-3 supplement used in the study.
It is important to note that the study assessed use of Omega-3 for eight weeks, at doses of 1050 mg of EPA and 150 mg of DHA each day. It is currently unknown whether taking higher doses or taking supplements over a longer period would yield different results.
These encouraging results show that use of EPA is effective among patients with unipolar depression unaccompanied by an anxiety disorder. Additional research directly comparing Omega-3 with conventional antidepressants could more clearly confirm their usefulness for patients suffering from depression.
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Centre hospitalier de l’Université de Montréal, via EurekAlert!, a service of AAAS.
Journal Reference:
- François Lespérance, Nancy Frasure-Smith, Elise St-André, Gustavo Turecki, Paul Lespérance, Stephen R. Wisniewski. The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 2010; DOI: 10.4088/JCP.10m05966blu
By Lindsey Tanner, AP Medical Writer
CHICAGO — A new study led by a federal drug safety expert ties the controversial diabetes drug Avandia
to a higher risk of heart problems, strokes and deaths in older adults, and says it is more dangerous than a rival drug, Actos.
The study, a huge review of Medicare records, comes two weeks ahead of a Food and Drug Administration hearing on Avandia’s safety. The lead
author, David Graham, is an FDA scientist who wants the pill banned.
As many as 100,000 heart attacks, strokes, deaths and cases of heart failure may be due to Avandia
since it came on the market in 1999, Graham said in an interview with The Associated Press.
Harms from Avandia are great enough to “put you in a hospital or in a cemetery,” he said.
Editors at the Journal of the American Medical Association rushed to release the study online on
Monday, so the information would be available before the July 13-14 hearing, a spokeswoman said.
Avandia is a once-blockbuster drug for Type 2 diabetes, the most common form of the disease and
the kind often tied to obesity. Avandia and Actos are pills that help the body make better use of insulin, a
key digestive hormone.
The American Heart Association issued a statement reminding patients not to stop taking any medicine
without talking with their doctors first. The new study is not definitive enough to prove harm but
“deserves serious consideration” and should be discussed between patients and their doctors, the
statement says.
Avandia has been under a cloud since May 2007, when a review of dozens of studies suggested it may
raise the risk of heart attacks and heart-related deaths. Warnings were added to its label, and the
American Diabetes Association told patients to avoid using it until safety questions were resolved.
The FDA and Congress have held meetings on the drug but it has remained on the market, still used by
hundreds of thousands of Americans.
Avandia’s maker, the British company GlaxoSmithKline PLC, maintains that its drug is safe.
A spokeswoman said the new study has limitations, and that the company looks forward to a full
discussion of evidence at the FDA hearing.
The study involved 227,571 Medicare patients, average age 74, who started on Actos or Avandia
from July 2006 through June 2009 and were followed for three years on average.
Avandia patients were 27% more likely to suffer strokes, 25% more likely to develop heart failure and
14% more likely to die than those on Actos, researchers found.
There were 2,593 heart attacks, heart failure cases, strokes and deaths among the 67,593 Avandia
users, and 5,386 of those problems among the 159,978 people taking Actos. Just dividing these
numbers to compare side effect rates can’t be done, though, because people were on the drugs for
differing lengths of time.
Unlike studies in younger patients that implicated Avandia, heart attack risks were similar in both
groups in the Medicare study. Sudden cardiac deaths are much more common in older adults, and
whether Avandia affects heart risks differently in older versus younger patients is unknown, the
researchers note.
The findings suggest that if 60 people were treated with Avandia for one year, one extra case of heart
failure, stroke or death would occur that could have been avoided if they’d taken Actos instead, Graham
said.
“The evidence is overwhelming,” he said. “There is not a single study where those two drugs are
compared where Avandia doesn’t look worse than Actos. How many studies do you have to do before
you come to your senses?”
The study was observational, with the researchers examining data on patients whose doctors had
prescribed Avandia or Actos. That’s less rigorous than studies that randomly assign patients to take
different drugs, and therefore cannot prove that the drug is riskier.
But Alvin Powers, a diabetes specialist at Vanderbilt University, called it “important information that’s
consistent with prior studies,” even if it is not definitive. He said he doesn’t prescribe Avandia
because of uncertainty over its safety.
Another AMA journal, Archives of Internal Medicine, on Monday released online an expanded analysis by
the same authors who did the original one in 2007; both suggest higher heart risks for Avandia.
At its hearing next month, the FDA plans to examine the latest safety data and air internal disagreement
among its scientists over what should be done.
At the FDA’s request, Glaxo began a big study last year comparing heart and stroke risks in patients on
Avandia or Actos, made by Japan’s Takeda Pharmaceuticals. It aims to enroll thousands of
patients, but an editorial in JAMA about the Medicare study says it would be unethical to let the study
continue.
The editorial, by David Juurlink of the University of Toronto, says it is hard to understand why patients
and doctors would choose Avandia when a safer alternative exists. He led a previous study of elderly
diabetics in Ontario that also found higher risks with Avandia versus Actos.
M. Adnan Nadir 1 , Benjamin R. Szwejkowski 1 & Miles D. Witham 2
1Department of Clinical Pharmacology, Centre for Cardiovascular and Lung
Biology, Division of Medicine, University of Dundee, Ninewells Hospital,
Dundee, UK 2Department of Ageing and Health, Centre for Cardiovascular and
Lung Biology, Division of Medicine, University of Dundee, Ninewells
Hospital, Dundee, UK
ABSTRACT
Vitamin D has been known to medical science for almost a century. Yet, it is
only in the last 15 years that we have realized that the biological effects
of vitamin D extend far beyond the control of calcium metabolism. Recent observational evidence suggests strong links between low vitamin D levels and a range of cardiovascular conditions, including stroke, myocardial infarction, hypertension, and diabetes. Interventional studies are beginning
to explore whether vitamin D supplementation can modify vascular health and prevent cardiovascular disease. This article reviews the physiology and function of vitamin D, examines the current observational and intervention data in cardiovascular disease, and discusses future research and current practice recommendations.
Jazeela Fayyaz, DO, Pulmonary Medicine, 11:34PM Apr 14, 2010
It seems like everyone is on Vitamin D replacement lately. A study published in the American Journal of Respiratory and Critical Care Medicine this winter looked at the effects of Vitamin D levels on steriod response in asthmatics. Adult, nonsmoking asthmatics were enrolled and the relantionship between serum 25 hydroxyvitamin D concentration and lung function, airway hyperresponsiveness and glucocorticoid response was evaluated. Higher vitamin D levels were associated with greater lung function, and patients with vitamin D levels <30ng/mL had increased airway hyperresponsiveness. Steriod response increased with increasing levels of Vitamin D. Checking vitamin D levels and supplementing in asthmatics may help improve their symptoms and the treatment response to steriods.
http://ajrccm.atsjournals.org/cgi/reprint/181/7/699
From Medscape Medical News:
Higher Vitamin D Levels Linked to Lower Risk for Female Pelvic Floor
Disorders
Laurie Barclay, MD
April 1, 2010 – Higher vitamin D levels are linked to a lower risk for
female pelvic floor disorders, according to the results from the National
Health and Nutrition Examination Survey (NHANES) reported in the April issue
of Obstetrics & Gynecology.
“Because vitamin D receptors are present in human muscle tissue, a direct
effect of vitamin D on muscle physiology is biologically plausible,” write
Samuel S. Badalian, MD, PhD, and Paula F. Rosenbaum, PhD, from SUNY Upstate
Medical University and St. Joseph’s Hospital Health Center in Syracuse, New
York. “Thus, it is not surprising that vitamin D deficiency has long been
clinically associated with impaired muscle strength and loss of muscle mass.
Given that vitamin D insufficiency or deficiency is epidemic among adults,
it is plausible that low vitamin D status contributes to the development of
poor muscle strength and can lead to different pelvic floor disorders such
as urinary/fecal incontinence and POP [pelvic organ prolapse].”
The goal of the study was to determine the rate of vitamin D deficiency in
women with pelvic floor disorders and to examine possible relationships
between vitamin D levels and pelvic floor disorders. This cross-sectional
analysis of 2005-2006 NHANES data included 1881 nonpregnant women older than
20 years in whom data on pelvic floor disorders as well as vitamin D
measurements were available. Insufficient vitamin D levels were defined as
those lower than 30 ng/mL. Data were analyzed regarding demographic factors,
pelvic floor disorders, and vitamin D levels, accounting for the multistage
sampling design. After controlling for known risk factors, the investigators
calculated odds ratios (ORs) and 95% confidence intervals (CIs) to determine
associations between vitamin D levels and pelvic floor disorders.
Nearly one quarter (23%) of women reported 1 or more pelvic floor disorders.
Regardless of age, women reporting at least 1 pelvic floor disorder and
those with urinary incontinence had significantly lower mean vitamin D
levels.
With increasing vitamin D levels, risks for 1 or more pelvic floor disorders
were significantly decreased in all women at least 20 years old (OR, 0.94;
95% CI, 0.88 – 0.99) and in the subset of women 50 years and older (OR,
0.92; 95% CI, 0.85 – 0.99), based on adjusted logistic regression models. In
women at least 50 years old with vitamin D levels of 30 ng/mL or higher (OR,
0.55; 95% CI, 0.34 – 0.91), the likelihood of urinary incontinence was
significantly reduced.
“Higher vitamin D levels are associated with a decreased risk of pelvic
floor disorders in women,” the study authors write. “The vitamin D
association was strongest among older women reporting urinary incontinence
in the NHANES survey. The pattern was similar for fecal incontinence
although not significant.”
Limitations of this study include drifts in the assay performance of vitamin
D levels with time, limited power regarding subtype analyses, and lack of
gynecologic examination to assess the severity of pelvic organ prolapse.
Contrary to expectation, vaginal bulge was reported more frequently among
those with higher vitamin D levels.
“Given the increase in the number of patients with pelvic floor disorders,
further evaluation of the role of vitamin D is warranted, particularly
future research to assess the relationship between vitamin D levels and
pelvic muscle strength in women of all ages and racial/ethnic groups,” the
study authors conclude. “Our findings suggest that treatment of vitamin D
insufficiency and deficiency in both premenopausal and postmenopausal women
could improve pelvic muscle strength, with a possible reduction in the
prevalence of pelvic floor disorders including urinary incontinence.”
The study authors have disclosed no relevant financial relationships.
Obstet Gynecol. 2010;115:795-803. Abstract
25-Hydroxyvitamin D, dementia, and cerebrovascular pathology in elders receiving home services
J. S. Buell PhD, B. Dawson-Hughes MD, T. M. Scott PhD, D. E. Weiner MD, MS, G. E. Dallal PhD, W. Q. Qui MD, PhD, P. Bergethon MD, I. H. Rosenberg MD, M. F. Folstein MD, S. Patz PhD, R. A. Bhadelia MD, and K. L. Tucker PhD*
From the Friedman School of Nutrition Science and Policy (J.S.B., T.M.S., G.E.D., I.H.R., K.L.T.), Tufts University; Tufts Medical Center (T.M.S., D.E.W., W.Q.Q., M.F.F., S.P., R.A.B.), Tufts University School of Medicine; Jean Mayer USDA Human Nutrition Research Center on Aging (B.D.-H., G.E.D., I.H.R., K.L.T.); Beth Israel Deaconess Medical Center (R.A.B.); and Boston University Medical Center (P.B.), Boston, MA.
Background: Vitamin D deficiency has potential adverse effects on neurocognitive health and subcortical function. However, no studies have examined the association between vitamin D status, dementia, and cranial MRI indicators of cerebrovascular disease (CVD).
Methods: Cross-sectional investigation of 25-hydroxyvitamin D [25(OH)D], dementia, and MRI measures of CVD in elders receiving home care (aged 65–99 years) from 2003 to 2007.
Results: Among 318 participants, the mean age was 73.5 ± 8.1 years, 231 (72.6%) were women, and 109 (34.3%) were black. 25(OH)D concentrations were deficient (<10 ng/mL) in 14.5% and insufficient (10–20 ng/mL) in 44.3% of participants. There were 76 participants (23.9%) with dementia, 41 of which were classified as probable AD. Mean 25(OH)D concentrations were lower in subjects with dementia (16.8 vs 20.0 ng/mL, p < 0.01). There was a higher prevalence of dementia among participants with 25(OH)D insufficiency ( 20 ng/mL) (30.5% vs 14.5%, p < 0.01). 25(OH)D deficiency was associated with increased white matter hyperintensity volume (4.9 vs 2.9 mL, p < 0.01), grade (3.0 vs 2.2, p = 0.04), and prevalence of large vessel infarcts (10.1% vs 6.9%, p < 0.01). After adjustment for age, race, sex, body mass index, and education, 25(OH)D insufficiency (20 ng/mL) was associated with more than twice the odds of all-cause dementia (odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.2–4.2), Alzheimer disease (OR = 2.5, 95% CI 1.1–6.1), and stroke (with and without dementia symptoms) (OR = 2.0, 95% CI 1.0–4.0).
Conclusions: Vitamin D insufficiency and deficiency was associated with all-cause dementia, Alzheimer disease, stroke (with and without dementia symptoms), and MRI indicators of cerebrovascular disease. These findings suggest a potential vasculoprotective role of vitamin D.
Omega-3 deficiency causes 96,000 US deaths per year, say researchers
By Shane Starling, 26-Jun-2009
Related topics: Omega-3, Research, Nutritional lipids and oils,
Cardiovascular health, Cognitive and mental function
Omega-3 deficiency is the sixth biggest killer of Americans and more deadly
than excess trans fat intake, according to a new study. The Harvard
University researchers looked at 12 dietary, lifestyle and metabolic risk factors
such as tobacco smoking and high blood pressure and used a mathematical
model to determine how many fatalities could have been prevented if better
practices had been observed.
The study, jointly funded by the Centers for Disease Control and Prevention
(CDC) through the Association of Schools of Public Health, drew on 2005
data from the US National Health Center for Health Statistics. They
determined that there were 72,000-96,000 preventable deaths each year due to omega-3
deficiency, compared to 63,000-97,000 for high trans fat intake.
Continue reading Omega-3 deficiency causes 96,000 US deaths per year, say researchers
J Toxicol Environ Health A. 2008;71(21):1415-29.
Splenda alters gut microflora and increases intestinal p-glycoprotein and
cytochrome p-450 in male rats.
Abou-Donia MB, El-Masry EM, Abdel-Rahman AA, McLendon RE, Schiffman SS.
Department of Pharmacology, Duke University Medical Center, Durham, North Carolina 27708, USA. donia@duke.edu
Splenda is comprised of the high-potency artificial sweetener sucralose (1.1%) and the fillers maltodextrin and glucose. Splenda was administered by oral gavage at 100, 300, 500, or 1000 mg/kg to male Sprague-Dawley rats for 12-wk, during which fecal samples were collected weekly for bacterial analysis and measurement of fecal pH. After 12-wk, half of the animals from each treatment group were sacrificed to determine the intestinal expression of the membrane efflux transporter P-glycoprotein (P-gp) and the cytochrome P-450 (CYP) metabolism system by Western blot. The remaining animals were allowed to recover for an additional 12-wk, and further assessments of fecal microflora, fecal pH, and expression of P-gp and CYP were determined. At the end of the 12-wk treatment period, the numbers of total anaerobes, bifidobacteria, lactobacilli, Bacteroides, clostridia, and total aerobic bacteria were significantly decreased;
however, there was no significant treatment effect on enterobacteria. Splenda also increased fecal pH and enhanced the expression of P-gp by 2.43-fold, CYP3A4 by 2.51-fold, and CYP2D1 by 3.49-fold. Following the 12-wk recovery period, only the total anaerobes and bifidobacteria remained significantly depressed, whereas pH values, P-gp, and CYP3A4 and CYP2D1 remained elevated. These changes occurred at Splenda dosages that contained sucralose at 1.1-11 mg/kg (the US FDA Acceptable Daily Intake for sucralose is 5 mg/kg). Evidence indicates that a 12-wk administration of Splenda exerted numerous adverse effects, including (1) reduction in beneficial fecal microflora, (2) increased fecal pH, and (3) enhanced expression levels of P-gp, CYP3A4, and CYP2D1, which are known to limit the bioavailability of orally administered drugs.
Publication Types:
Research Support, Non-U.S. Gov’t
PMID: 18800291 [PubMed - indexed for MEDLINE]
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